Silicone Implant Incompatibility Syndrome

The safety of silicone-containing breast implants has been challenged since their introduction. The emergence of the Autoimmune Syndrome Induced by Adjuvants (ASIA) is associated with individual genetic predisposition, for instance those carrying HLA-DRB1*01 or HLA-DRB4, and results from exposure to external and/or endogenous triggers. Adjuvants have demonstrated to be able to induce autoimmune phenomena in both animal models and humans, via diverse mechanisms including effects on cellular immunity, polyclonal activation of B cells, and alteration of the host’s immune system. Silicone Incompatibility Syndrome (SIIS), as well as the other four clinical entities of the ASIA syndrome, presents similar clinical manifestations including arthralgia, myalgia, myositis, skin alterations, cognitive and/or neurological symptomatology, sleep disturbances, dry mouth, fever, and chronic fatigue syndrome. Recently, it has been proposed that silicone breast implants (SBI) stimulate a specific antigen-driven local immune response through activated Th1/Th17 cells, which suggests that local fibrosis is promoted by the production of profibrotic cytokines due to faltering function of local T regulatory cells. In addition, new profile of positive autoantibodies has been identified among women carrying SBI. Moreover, clinical symptoms such as chronic fatigue, depression, cognitive impairment, and sleep disturbances were found to be associated with small-fiber neuropathy and dysregulation of the levels of circulating autoantibodies. Hence, these autoantibodies can play a significant role in the development of suspected autoimmune dysautonomia-related disorders and might explain some of the enigmatic, subjective manifestations reported by patients. Likewise, they could have future diagnostic significance in silicone-associated diseases. Ultimately, attention should be raised on the possible impact of SBI in women health, not only promoting awareness of the scientific community to the existence of the SIIS but also seeking a personal and individualized advice to patients who might be at risk.